Guinea Worm

Guinea Worm

Guinea Worm

What Is Guinea Worm? A parasite that enters the human body in contaminated drinking water, grows for almost a year and emerges through a burning blister in the skin.

Symptoms: Symptoms begin just before the worm starts to emerge from the blister. Victims suffer intense pain, often accompanied by bacterial infection and inability to walk.

Can It Be Eradicated? Yes. With no medical cure or vaccine, eradication will be achieved by interrupting the life cycle of the parasite through education, community empowerment, and low-tech interventions like water filtration.

Status: On track for ERADICATION

On the Cusp of Eradication

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In 1986, Guinea worm disease was common in 21 countries across Africa and Asia. Today, it exists in isolated areas of just four African nations.

Only one human disease, smallpox, has ever been eradicated. But soon a second infection will join the list: Guinea worm disease, a painful and debilitating condition caused by the Guinea worm—known to many as the “fiery serpent.” There is no medicine to cure Guinea worm disease and no vaccine to prevent it. Yet it can be stopped.

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Guinea worm is not new. Many scholars believe the biblical “fiery serpents” that attacked the children of Israel in the Old Testament were actually Guinea worms. A calcified Guinea worm was even discovered in a 3,000-year-old Egyptian mummy. This engraving from the 1600s shows physicians in Persia (now Iran) removing Guinea worms from their patients’ legs.

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G. H. Velschius, 1674. United States National Library of Medicine

G. H. Velschius, 1674. United States National Library of Medicine

A Case Study In South Sudan

As recently as 1986, Guinea worm disease afflicted some 3.5 million people every year across Africa and Asia. Since then, the number of cases has been reduced by more than 99.99%. The Carter Center has led the herculean effort, together with its many partners, educating and empowering communities in Asia and Africa to bring the fiery serpent to the edge of extinction.

The Curse of the Fiery Serpent

Humans have known the searing pain of Guinea worm disease since ancient times, and the common treatment for the disease goes back centuries as well. It involves wrapping the worm around a stick or piece of gauze while gradually—but painfully—extracting it over several weeks. Emerging worms often cause secondary bacterial infection, and depending where the worm is, there can be long-term paralysis.

On a human level, Guinea worm’s effects are painful and debilitating. On an economic level, they are disastrous. Infected children cannot attend school, and adults cannot farm or tend to their cattle. In Mali, Guinea worm is known as “the disease of the empty granary” because of the starvation it has caused.

Children Suspected of Guinea Worm. South Sudan, 2013

Swellings beneath the bandages on these boys’ feet may hide Guinea worms preparing to emerge. By staying at a case containment center, the boys avoid contaminating public waters. And if worms do emerge, they can be safely removed and the wounds treated.

The Carter Center/Louise Gubb

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Extracting a Guinea Worm. South Sudan, 2013

Extracting a Guinea worm is a slow and painful process. Some historians believe the medical symbol known as the Staff of Asclepius—a snake coiled around a stick—was inspired by the age-old method of Guinea worm extraction.

The Carter Center/Louise Gubb

Extracting a Guinea Worm. South Sudan, 2013

Extracting a Guinea worm is a slow and painful process. Some historians believe the medical symbol known as the Staff of Asclepius—a snake coiled around a stick—was inspired by the age-old method of Guinea worm extraction.

Four-year-old Rafia receives treatment for an infected Guinea worm at a hospital in Savelugu, Ghana. When The Carter Center began working on eradication in 1986, Ghana ranked second in the world in Guinea worm cases. In 2010, Ghana recorded its last case of the disease in 2010, and was certified Guinea worm-free by the WHO in 2015.

Four-year-old Rafia receives treatment for an infected Guinea worm at a hospital in Savelugu, Ghana. When The Carter Center began working on eradication in 1986, Ghana ranked second in the world in Guinea worm cases. In 2010, Ghana recorded its last case of the disease in 2010, and was certified Guinea worm-free by the WHO in 2015.

The Carter Center/Louise Gubb

Worm-Free Water

Guinea worm disease is spread through water—more specifically, by the copepods that carry Guinea worm larvae. These tiny crustaceans—no more than a couple of millimeters long—thrive in the stagnant ponds and lakes that provide the only source of drinking water in many communities.

Filtering water through a simple mesh fabric, however, removes the copepods, rendering the water 100% Guinea worm free. Since the early 1990s, The Carter Center has worked closely with national health ministries to distribute millions of free filters, teach people how to use them properly and help residents understand the importance of water filtration. Although it hasn’t been easy, this low-tech intervention has prevented millions of cases of Guinea worm disease across sub-Saharan Africa and parts of Asia.

A Refreshing Drink. Sudan/South Sudan, 2010

A small piece of steel mesh inside a plastic drinking tube offers a low-tech way to filter water on the go. The Carter Center has collaborated with national governments, local volunteers and other organizations to distribute more than 23 million of these free “pipe filters.”

Rafia (in blue) and her sisters all suffered from multiple emerging Guinea worms just a year before this photograph was taken. Rafia is pictured with President and Mrs. Carter in another photograph above. The sisters now filter their drinking water to ensure the disease will not return.

The Carter Center/Louise Gubb

Rafia Fusseini and Her Sisters.Ghana, 2008

Rafia (in blue) and her sisters all suffered from multiple emerging Guinea worms just a year before this photograph was taken. Rafia is pictured with President and Mrs. Carter in another photograph above. The sisters now filter their drinking water to ensure the disease will not return.

The Carter Center/Louise Gubb

Tracking and Containment

When the goal is eradication, it’s not enough to stop some or even most cases of the disease. Health workers must work tirelessly to track down every single case of Guinea worm disease. When a suspected case is reported, teams set out to find the afflicted person, confirm the diagnosis, identify the infected water source, and break the chain of transmission as quickly as possible. Only when every case is contained can eradication be achieved. Suspected Guinea worm patients are encouraged to come to “case containment centers,” which keep the patients from entering local water sources and spreading the disease. At these centers, worms are also safely extracted and patients have access to bathing facilities, fresh bedding, latrines and healthy food for themselves and their families.

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Surveillance Team. South Sudan, 2013

Makoy Samuel Yibi (center), South Sudan’s Guinea Worm Eradication Program Director, leads a team that includes technical assistants, village volunteers and the husband of a patient from a nearby containment center. They are trying to identify where the patient contracted the disease and any other water sources she may have contaminated.

The Carter Center/Louise Gubb

Surveillance Team. South Sudan, 2013

Makoy Samuel Yibi (center), South Sudan’s Guinea Worm Eradication Program Director, leads a team that includes technical assistants, village volunteers and the husband of a patient from a nearby containment center. They are trying to identify where the patient contracted the disease and any other water sources she may have contaminated.

The Carter Center/Louise Gubb

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Life at a Containment Center. South Sudan, 2013

Guinea worm patients are encouraged to come to case containment centers as soon as they suspect an infection—and before a worm emerges. Containment centers provide free treatment and healthy meals for patients and their families, many of whom are undernourished.

The Carter Center/Louise Gubb

Life at a Containment Center. South Sudan, 2013

Guinea worm patients are encouraged to come to case containment centers as soon as they suspect an infection—and before a worm emerges. Containment centers provide free treatment and healthy meals for patients and their families, many of whom are undernourished.

Health Education

While the tools of Guinea worm eradication—a plastic tube or cloth filter—may seem simple, the process of eradication is anything but simple. It’s not enough to hand out filters or establish containment centers. People will only change their behavior if they understand the need for these interventions and are convinced of their value. That’s where education comes in.

Throughout sub-Saharan Africa, thousands of local volunteers have been trained not only to treat infection, but also to raise awareness and teach others about the disease. At the peak of the eradication effort, village volunteers were operating in more than 23,000 African villages. Because many people can’t read, workers get the message out in creative ways—through T-shirts, picture books, performances, radio broadcasts and visits from national leaders.

Health Education. South Sudan, 2013

Paulo Lovul (blue shirt) is a South Sudan Guinea Worm Eradication Program Area Supervisor, and Aleper Akol Naparinga is a local village volunteer. Together, they use a flip chart to teach children and adults how to avoid contracting Guinea worm disease.

The Carter Center/Louise Gubb

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Looking for Copepods. South Sudan, 2013

Field Officer Emmanuel Ekadeli points out the tiny crustaceans, called copepods, that carry Guinea worm disease from one person to another. Ekadeli and his colleagues work hard to challenge popular misconceptions about Guinea worm disease—including beliefs that the illness is caused by witchcraft.

The Carter Center/Louise Gubb

Looking for Copepods. South Sudan, 2013

Field Officer Emmanuel Ekadeli points out the tiny crustaceans, called copepods, that carry Guinea worm disease from one person to another. Ekadeli and his colleagues work hard to challenge popular misconceptions about Guinea worm disease—including beliefs that the illness is caused by witchcraft.

The Carter Center/Louise Gubb

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Comic Book. Ghana, 2007

An educational comic book captures the attention of Guinea worm patients Sadia Mesuna (right) and Fatawu Yakubu at a case containment center in Ghana.

The Carter Center/Louise Gubb

Comic Book. Ghana, 2007

An educational comic book captures the attention of Guinea worm patients Sadia Mesuna (right) and Fatawu Yakubu at a case containment center in Ghana.

The Carter Center/Louise Gubb

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Washing at Kuse Dam. Sudan/South Sudan, 2010

A woman does her washing near a dam in southern Sudan. Nearby, a sign cautions against entering the water while infected with Guinea worm.

The Carter Center/Louise Gubb

Washing at Kuse Dam. Sudan/South Sudan, 2010

A woman does her washing near a dam in southern Sudan. Nearby, a sign cautions against entering the water while infected with Guinea worm.

The Carter Center/Louise Gubb

Challenges

After decades of intense work, Guinea worm eradication is nearly complete. And yet the final push will be especially difficult. The last few cases will likely be found in some of the most remote and war-torn communities. But an eradication effort isn’t successful until it succeeds everywhere.

The remaining endemic areas are mostly insecure or conflict-ridden zones. Fighting in parts of South Sudan and northern Mali make it extremely difficult for health workers to move about freely and to provide necessary services. Refugees from war zones—in addition to the movements of nomadic populations—add to the challenges of tracking and containing new cases.

A more recent challenge is a large number of domesticated dogs in Chad contracting Guinea worm. In Chad’s fishing villages, dogs eat raw fish or fish guts carrying Guinea worm larvae and are infected, even though they are not the parasite’s natural host.

Cattle Camp. Sudan/South Sudan, 2010

During South Sudan’s dry season, men traditionally stay at temporary cattle camps while watching over their families’ herds. It’s tough for health workers to track the sources of new Guinea worm cases and keep the disease from spreading in these often chaotic, transient settlements.

The Carter Center/Emily Howard Staub

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Stuck in the Mud. South Sudan, 2011

Difficult travel is one of many challenges hampering efforts in South Sudan. Although the country is nearly the size of Texas, there are few paved roads outside of the capital.

The Carter Center/Thalia Sparling

Stuck in the Mud. South Sudan, 2011

Difficult travel is one of many challenges hampering efforts in South Sudan. Although the country is nearly the size of Texas, there are few paved roads outside of the capital.

The Carter Center/Thalia Sparling

Successes

The global Guinea Worm Eradication Program has already prevented some 80 million cases of Guinea worm disease while educating and empowering people in thousands of communities. And by working closely with local and national health providers, the campaign has helped to strengthen the healthcare infrastructure in 21 African and Asian countries.

Where Guinea worm has been eliminated, adults can work without interruption and children attend school more regularly. Poverty has decreased, and productivity has gone up.

Former Guinea Worm Patient. Ghana, 2013

Abdulai Iddrisu doesn’t have to miss school anymore because of Guinea worm infections. Thanks to the work of the Ghana Guinea Worm Eradication Program and The Carter Center, future generations of Ghanaian children will never know the pain of “the fiery serpent.”

The Carter Center/Peter DiCampo

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Former Guinea Worm Patient. Ghana, 2013“Oh, how it hurt!” Suleiman Alidu recalls. “I was in so much pain. I never left the house…I thought I was never going to be able to walk again.” Now that he no longer suffers from Guinea worm disease, Alidu has returned to his fields.Using a local expression of joy he adds, “My heart is white!”

The Carter Center/Peter DiCampo

Former Guinea Worm Patient. Ghana, 2013“Oh, how it hurt!” Suleiman Alidu recalls. “I was in so much pain. I never left the house…I thought I was never going to be able to walk again.” Now that he no longer suffers from Guinea worm disease, Alidu has returned to his fields.Using a local expression of joy he adds, “My heart is white!”

The Carter Center/Peter DiCampo

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A Village’s Last Case of Guinea Worm. South Sudan, 2013Village volunteer Cezerina Puru Ladu poses with her three-year-old daughter and husband, Garbino, who suffered from Guinea worm disease in 2010. Garbino was the last Guinea worm patient in Senwei village, which is no longer plagued by the debilitating disease.

The Carter Center/Louise Gubb

A Village’s Last Case of Guinea Worm. South Sudan, 2013Village volunteer Cezerina Puru Ladu poses with her three-year-old daughter and husband, Garbino, who suffered from Guinea worm disease in 2010. Garbino was the last Guinea worm patient in Senwei village, which is no longer plagued by the debilitating disease.